Aortic stenosis causes: Difference between revisions
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==Overview== | ==Overview== | ||
Aortic stenosis can be categorized under two methods of causation: '''acquired''' and '''congenital'''. Research regarding the influence of preventative therapies on causation is mixed. More research is needed specifically looking at cholesterol lowering interventions and their role on disease onset. | Aortic stenosis can be categorized under two methods of causation: '''acquired''' and '''congenital'''. Research regarding the influence of preventative therapies on causation is mixed. More research is needed specifically looking at cholesterol lowering interventions and their role on disease onset. | ||
Aortic stenosis is most commonly caused by age-related progressive calcification of the normal tricuspid aortic valve (>50% of cases). Other causes include calcification of a congenital [[bicuspid aortic valve]] (30-40% of cases) and [[acute rheumatic fever]] (less than 10% of cases) <ref name=uas>VOC=VITIUM ORGANICUM CORDIS, a compendium of the Department of Cardiology at Uppsala Academic Hospital. By Per Kvidal September 1999, with revision by Erik Björklund May 2008</ref>. | |||
Normal valves have three leaflets (tricuspid), but some valves have two leafs (bicuspid). Typically, aortic stenosis due to calcification of a bicuspid valve appears earlier, in the 40s and 50s, whereas that due to calcification of a normal valve appears later, in the 70s and 80s. [[Hypertension]], [[diabetes mellitus]], [[hyperlipoproteinemia]] and [[uremia]] may speed up the process.<ref name=uas/> | |||
==Complete Differential Diagnosis for the Causes of Aortic Stenosis== | ==Complete Differential Diagnosis for the Causes of Aortic Stenosis== | ||
Revision as of 17:03, 11 October 2011
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Aortic Stenosis Microchapters |
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Diagnosis |
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Treatment |
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Percutaneous Aortic Balloon Valvotomy (PABV) or Aortic Valvuloplasty |
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Transcatheter Aortic Valve Replacement (TAVR) |
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Case Studies |
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Aortic stenosis causes On the Web |
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American Roentgen Ray Society Images of Aortic stenosis causes |
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Risk calculators and risk factors for Aortic stenosis causes |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-In-Chief: Claudia P. Hochberg, M.D. [2], Abdul-Rahman Arabi, M.D. [3], Keri Shafer, M.D. [4], Priyamvada Singh, MBBS [5], Mohammed A. Sbeih, M.D. [6]; Assistant Editor-In-Chief: Kristin Feeney, B.S. [7]
Overview
Aortic stenosis can be categorized under two methods of causation: acquired and congenital. Research regarding the influence of preventative therapies on causation is mixed. More research is needed specifically looking at cholesterol lowering interventions and their role on disease onset.
Aortic stenosis is most commonly caused by age-related progressive calcification of the normal tricuspid aortic valve (>50% of cases). Other causes include calcification of a congenital bicuspid aortic valve (30-40% of cases) and acute rheumatic fever (less than 10% of cases) [1].
Normal valves have three leaflets (tricuspid), but some valves have two leafs (bicuspid). Typically, aortic stenosis due to calcification of a bicuspid valve appears earlier, in the 40s and 50s, whereas that due to calcification of a normal valve appears later, in the 70s and 80s. Hypertension, diabetes mellitus, hyperlipoproteinemia and uremia may speed up the process.[1]
Complete Differential Diagnosis for the Causes of Aortic Stenosis
| Cardiovascular | . |
| Chemical / poisoning | No underlying causes |
| Dermatologic | No underlying causes |
| Drug Side Effect | Some medications may cause aortic stenosis, such as |
| Ear Nose Throat | No underlying causes |
| Endocrine | No underlying causes |
| Environmental | Radiation. |
| Gastroenterologic | No underlying causes |
| Genetic | No underlying causes |
| Hematologic | . |
| Iatrogenic | Radiation treatment to the chest. |
| Infectious Disease | Bacterial endocarditis where the vegetations may favor increase risk of stenosis. |
| Musculoskeletal / Ortho | No underlying causes |
| Neurologic | No underlying causes |
| Nutritional / Metabolic | No underlying causes |
| Obstetric/Gynecologic | No underlying causes |
| Oncologic | . |
| Opthalmologic | No underlying causes |
| Overdose / Toxicity | No underlying causes |
| Psychiatric | No underlying causes |
| Pulmonary | No underlying causes |
| Renal / Electrolyte | No underlying causes |
| Rheum / Immune / Allergy | . |
| Sexual | No underlying causes |
| Trauma | No underlying causes |
| Urologic | No underlying causes |
| Miscellaneous | No underlying causes |
The etiology of Left-Sided Outflow Obstruction can be divided into two broad categories:
- Acquired Aortic Stenosis and
- Congenital Left-Sided Outflow Obstruction
Major causes and predisposing conditions of aortic stenosis include acute rheumatic fever and bicuspid aortic valve. As individuals age, calcification of the aortic valve may occur and result in stenosis. This is especially likely to occur in people with a bicuspid aortic valve, but also occurs in the setting of perfectly normal valves as a result of age-induced 'wear and tear'. Typically, aortic stenosis due to calcification of a bicuspid valve occurs in the 4th of 5th decade of life, whereas symptomatic onset due to calcification of a normal valve tends to occur later - around the 7th or 8th decade.
Of the various forms of aortic stenosis, the calcific type is predominant. Since calcific aortic stenosis shares many pathological features and risk factors with atherosclerosis. As atherosclerosis may be prevented and/or reversed by cholesterol lowering, there has been interest in attempting to modify the course of calcific aortic stenosis by cholesterol lowering with statin drugs. Although a number of small, observational studies demonstrated an association between lowered cholesterol and decreased progression, and even regression, of calcific aortic stenosis. A large randomized clinical trial, published in 2005, failed to find any predictable effect of cholesterol lowering on calcific aortic stenosis. Researchers in 2007 study conversely demonstrated a slowing of aortic stenosis with the statin rosuvastatin.[2] More research is necessary to further clarify the specific mechanisms of disease onset and the influence of interventional methodologies on overall causation.
Congenital bicuspid valve is the most frequent form of congenital heart disease affecting approximately 1-2% of the population. 1/3rd of Supravalvular Aortic Stenosis cases are transmitted as an autosomal dominant trait as 60% of patients with supravalvular obstruction have Williams syndrome (supravalvular obstruction, intellectual impairment and facial abnormalities).
Differential Diagnosis of the Causes of Aortic Stenosis
References
- ↑ 1.0 1.1 VOC=VITIUM ORGANICUM CORDIS, a compendium of the Department of Cardiology at Uppsala Academic Hospital. By Per Kvidal September 1999, with revision by Erik Björklund May 2008
- ↑ Moura LM, Ramos SF, Zamorano JL; et al. (2007). "Rosuvastatin affecting aortic valve endothelium to slow the progression of aortic stenosis". J. Am. Coll. Cardiol. 49 (5): 554–61. doi:10.1016/j.jacc.2006.07.072. PMID 17276178.